Abstract
Anhydrous ammonia is a toxic gas widely used as a fertilizer. In 2016 about 12 milliontons of ammonia were used in the production of fertilizers. We are reporting a case of severepulmonary toxicity from anhydrous ammonia fertilizer exposure. An 80-year-old male farmerwas accidentally exposed to anhydrous ammonia released from a pressurized fertilizer tank.He was intubated due to upper airway inhalation injury. Bronchoscopy showed extensivelower airway mucosal damage. The sloughed bronchial mucosa was removed from obstructedbronchi using a cryoprobe. He developed acute respiratory distress managed with lungprotective mechanical ventilation. He did not improve and tracheostomy was recommended.The patient’s family opted for comfort care only. Anhydrous ammonia can cause pulmonarytoxicity. Symptoms range from mild to severe and can be fatal at doses greater than 5,000parts per million. Early inspection of the upper respiratory tract and securing an airway arelifesaving. Management is supportive with oxygen and mechanical ventilation. Education, theuse of protective gear, and proper equipment handling are key steps in the prevention ofaccidental toxicity.
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